March 5, 2024   5 mins

Katie told me she sometimes thinks about wanting to lose weight. The 14-year-old had started skipping lunch from time to time at school, and sometimes didn’t finish her dinner at home. I was assessing her for anxiety, but when a child discloses restricted eating, there’s a protocol: write down everything they’ve eaten over the last few days; ask if they ever feel dizzy; log any changes to their weight and get them checked out at the GP. It doesn’t matter if they’re not underweight; atypical anorexia exists. Katie was actually overweight, and always had been. Her desire to lose weight might not have been unhealthy — but the narrative that prevails in many schools pathologised it.

I work as part of an early intervention team that assesses children’s mental health, and I have noticed that teachers, parents and healthcare professionals seem increasingly terrified of talking to children about their weight. In many ways, this is understandable. Eating disorders in children are on the rise, with over 11,000 children and young people beginning treatment last year on the NHS (a figure that has more than doubled since 2016). And there is a common — if not always accurate — perception that they are triggered by body image issues.

The trouble is, we need to talk about children’s weight. Britain is experiencing an obesity crisis that is putting them at risk of lifelong illness. Last year, almost a quarter of children in Year 6 were considered obese. In the early Eighties, only 1% of children were obese. And in 2020, a third of UK teenagers began their adult lives with excess weight. It’s obvious but worth stating that obesity has all sorts of negative consequences, not only for children’s health but also their social lives. Obese young people are less physically active, for instance, missing out on opportunities to develop skills, relationships and strategies for managing their mental health. They are also more likely to develop type 2 diabetes, high blood pressure and liver disease at an early age.

And yet, the authorities responsible for children often seem far more comfortable discussing restricted eating than over-eating. This is a society-wide phenomenon, affecting adults as well as children. Healthcare professionals are routinely criticised for mentioning excess weight at check-ups. When Cancer Research publicised the well-established links between obesity and cancer, academics and activists attacked them for fat-shaming. And the body positivity movement preaches that you can be healthy at any size.

“The authorities responsible for children often seem far more comfortable discussing restricted eating than over-eating.”

It’s easy to sympathise with the aims of this movement. Obese people do get treated unfairly, and often harshly, by society. They are more likely to be judged as lazy, weak-willed and unintelligent, and they earn less money. One of the reasons Katie, the 14-year-old I assessed, wanted to lose weight was that she had been bullied about being overweight in primary school. And when I met 12-year-old Leo, to work out why he was missing so much school, he told me he never came in on PE days because he would have to get changed in front of people. He is overweight, and worried about being teased.

Teachers at school, trying to do the right thing, told him not to let other people’s opinions get to him. But Leo was already doing this, to an extent. Even though he felt like people were looking at him, he told me he knew they probably weren’t. He admitted that insensitive comments definitely fed his anxieties, but said that he knew they were made in jest, and that nobody meant to hurt him with them. But still, Leo wanted to lose weight, and when he asked adults for help, all he got were platitudes, or at best a link to a healthy eating website. The odd rude comment may have been a problem, but adults in his life focused on them as the only problem, ignoring Leo’s entirely rational desire to be a healthy weight.

Two things can be true: overweight kids don’t want to be shamed for their weight, but they usually still want to lose it. Our increased awareness of body image issues is on the whole a positive thing — but it has created a tendency to catastrophise. We see restricted eating in children as disordered eating, and therefore believe it ought to be avoided at all costs. Parents can know their child is overweight and want to do something about it, but still be terrified that if they say anything, they might trigger lifelong insecurities, or even anorexia.

This is, partly, down to common misconceptions of what causes the eating disorder. Anorexia, especially in the severe forms that see people hospitalised, is not strictly caused by body image issues — or seeing pictures of very thin models in magazines — though they can sometimes act as a catalyst. A colleague who worked in an inpatient eating disorder unit described the complex webs of troubled family dynamics, trauma and obsessive tendencies that feature on the ward: histories of abuse, or ambivalent parents who didn’t visit, and the sorts of counting and checking behaviours we associate with OCD.

At the same time, the causes of obesity are likewise poorly understood. It’s widely recognised that there are significant socioeconomic differences: children in the most deprived areas are more than twice as likely to be obese as those in the richest areas. For a while, the idea of the food desert seemed to help explain this — if you’re stuck in an area with small convenience stores that tend to stock junk rather than bigger supermarkets, your options will be limited. But more recent research showed this to be a myth: poorer families mostly shop in big, better value supermarkets, just like everyone else. And obesity figures are still very high for children in wealthy areas, 13% of whom are obese by the end of primary school.

A more reliable predictor of obesity in children is their parents’ choices. Adults shape their children’s bodies as much as their own. Their eating habits will be mirrored in their children’s: adults who eat unhealthy food at home are likely to feed unhealthy food to their children. So the fact that nearly two-thirds of UK adults are overweight, and 28% obese, is implicated in the child obesity crisis.

In theory, programmes exist that support the whole family in managing children’s weight, drawing on everything from behavioural psychology to nutrition and free local sporting activities. But access varies across areas: there is nothing on offer for children in my county, for example, and in better-resourced areas these programmes are only available to families when their child’s BMI is already very high, even though research shows that the higher your BMI is, the harder it is to lose weight. Until that point, all that local authorities and the NHS provide is information about healthy eating. And we all know about our five a day. You can’t move through a primary school without seeing a healthy eating display board. If public health information campaigns worked, we’d be looking leaner.

The structural problems are partly to blame, of course. Doctors, teachers and parents can’t change the fact that we live in a time of superabundance in which we are surrounded by cheap, delicious food. It is extremely difficult to maintain the willpower to give up a pleasurable and compelling habit. But it becomes near-impossible if you’re in two minds about it. And if the prevailing narrative is that dieting is inherently unhealthy, or that the desire to lose weight is a sign of a dangerous mental health problem, of course you’ll prioritise your emotional wellbeing.

The reality is, most adults have two options: the discomfort of watching what we eat or the discomfort of being overweight. Learning how to feed yourself properly is part of growing up — like learning to navigate conflict or hold down a job. It’s not necessarily fun or particularly fulfilling — it’s just life. If we want child obesity rates to come down, adults will firstly need to acknowledge that fact.

We will also need to provide the structure and support to help with weight loss. An 11-year-old girl I worked with started secondary school worrying about her weight, but felt much better two months later — not because of any magical intervention from our team, but because her mum signed the whole family up to the gym and made them all go at least twice a week. Having done that, the girl explained, the family started thinking more about what to eat, and it felt easier to choose better food, because they were all on the same team.

Without adults’ input, children can’t learn to manage their own bodies as they get older. We have come a long way in teaching them that we are all more than our bodies, and pushing back against an image-obsessed world that once promoted being underweight. But we mustn’t go so far as to ignore the awful consequences of being overweight. Obese people don’t deserve to be stigmatised, but they do deserve to be healthy.

Kate Adams works at a school in England.